CH 40, Concepts of Care for Patients with Problems of the Central Nervous System - The Spinal Cord

Which term is used for weakness in a patient's legs after a spinal cord injury (SCI)?

A. Paraparesis

Which patient condition is associated with a lower thoracic spinal cord injury?

A. Paraplegia

Which patient condition contraindicates ziconotide therapy?

B. Schizophrenia

The nurse obtains a cotton swab and paper clip before entering a patient's room. Which aspect is the nurse planning to focus on when assessing the patient?

B. Skin sensation

The nurse is caring for a patient admitted with an exacerbation of multiple sclerosis (MS). The patient reports urinary incontinence. Which primary urinary bladder alteration related to MS is the likely cause?

B. Spastic bladder

Which term is used for the complete but temporary loss of motor, sensory, reflex, and autonomic function after a spinal cord injury?

B. Spinal shock

Which secondary spinal cord injury results from increased interstitial fluid?

C. Local edema

Which antineoplastic drug has been shown to effectively reduce neurologic disability in patients with multiple sclerosis?

C. Mitoxantrone

Which finding is associated with relapsing-remitting multiple sclerosis (MS)? Select all that apply.

C. The patient returns to baseline. D. Loss of function occurs during the relapsing phase. E. Symptoms develop and resolve in weeks to months.

A patient with multiple sclerosis who is receiving drug therapy develops severe disability. A cerebrospinal fluid examination and MRI indicate progressive multifocal leukoencephalopathy (PML). Which change in therapy would the nurse anticipate for this patient?

D. Discontinuing natalizumab administration

A patient is admitted with a spinal cord injury at the fifth cervical vertebra secondary to a gunshot wound. Which intervention would the nurse prioritize for this patient's care?

D. Monitoring adequacy of ventilation

Which pharmacologic treatment would the nurse anticipate being prescribed first for the treatment of new onset back pain?

D. NSAIDs

Which information about the use of opioid analgesics in the treatment of acute low back pain would the nurse apply to planning care?

D. Opioids are no more effective than nonsteroidal analgesics and should be avoided.

Which action would the nurse take first for a patient who has a suspected cerebrospinal leak after back surgery?

D. Place the patient in a flat-lying position.

The nurse instructs a patient experiencing lower back pain to lie in a semi-Fowler posture with a pillow under the knees. Which type of nonsurgical conservative pain management therapy is the nurse recommending?

D. Positioning therapy

Which term is used for weakness in a patient's arms and legs after a spinal cord injury (SCI)? A. Paraparesis B. Hypoesthesia C. Hyperesthesia D. Quadriparesis

D. Quadriparesis

Which term describes excessive inward curvature of the spine? A. Lordosis B. Scoliosis C. Spinal shock D. Spinal stenosis

A. Lordosis

A patient diagnosed with multiple sclerosis has slurred speech. Which term would the nurse use for this speech pattern?

C. Dysarthria

The nurse is beginning a shift at work caring for several patients diagnosed with multiple sclerosis. Which reported finding in a patient would lead the nurse to assess that patient first? A. Ataxia B. Scotomas C. Dysphagia D. Paresthesia

C. Dysphagia

The patient with multiple sclerosis is experiencing cognitive impairment. Which intervention would the nurse recommend for home care?

C. Educating the patient to keep medications in a familiar place

A patient with multiple sclerosis will begin therapy with fingolimod. Which instruction would the nurse give the patient about this drug?

A. Monitor the pulse daily.

The nurse is performing a postoperative assessment on a patient after an open back diskectomy. Which color of wound drainage would cause the nurse to suspect a cerebrospinal fluid leak?

A. Clear

Which medication would the nurse expect to be prescribed for a patient with a lumbosacral injury who has a blood pressure of 80/50 mm Hg?

A. Dextran

Which patient problem would the nurse anticipate to be the primary concern of a patient who has lower back pain?

C. Continuous pain

Which mechanism of spinal cord injury occurs when the head TURNs beyond the normal range? A. Hyperflexion B. Hyperextension C. Excessive rotation D. Vertical compression

C. Excessive rotation

Which secondary spinal cord injury typically results from reduced or absent blood flow? A. Ischemia B. Hemorrhage C. Local edema D. Hypovolemia

A. Ischemia

Which assessment finding supports the nurse's suspicion that a patient has a herniated nucleus pulposus (HNP) of the lumbosacral area? Select all that apply.

A. Leg pain D. Numbness E. Muscle weakness

Which ocular or vision-related finding is a complication of multiple sclerosis (MS)? Select all that apply.

A. Diplopia B. Scotomas D. Nystagmus

Which intervention would the nurse plan for a patient diagnosed with multiple sclerosis who is experiencing cognitive impairment?

A. Encourage the use of written lists.

Which finding would alert the nurse that a patient with a spinal cord injury is experiencing autonomic dysreflexia? Select all that apply.

A. Headache B. Bradycardia C. Hypertension D. Nasal stuffiness

A patient who has just undergone spinal surgery must be repositioned. Which action would the nurse take to move this patient?

A. Log rolling the patient to the side

Which diagnostic test is indicated for a patient experiencing severe numbness and tingling of the right hand and fingers? Select all that apply.

B. Myelogram C. Nerve conduction studies D. CT of the neck E. MRI of the neck

Which cervical disk space is most often affected by spinal nerve root compression?

C. C5-6

The nurse teaches a patient who has undergone anterior cervical diskectomy and fusion about home care. Which statement made by the patient indicates a need for additional instruction?

D. "I should wear a brace for up to 10 weeks."

The health care team teaches self-management techniques to a patient with multiple sclerosis. Which statement made by the patient indicates the need for further teaching?

D. "I will have sauna and steam baths as instructed by the physical therapist."

A patient diagnosed with multiple sclerosis is examining the use of complementary therapies. Which statement by the patient indicates a need for further teaching?

D. "Massage and acupuncture may allow me to stop using medications."

The daughter of a patient diagnosed with multiple sclerosis expresses concern over the patient's inappropriate behavior in social situations. Which response would the nurse provide?

D. "You can develop a cue to alert your parent to modify actions."

Which type of spinal cord injury causes tearing of posterior ligaments and dislocation of the patient's vertebrae? Axial loading. Hyperflexion. Hyperextension. Penetrating trauma

Hyperflexion

The nurse is developing a teaching plan for a patient with a history of low back pain. Which instruction would the nurse plan to include? Select all that apply.

A. "Do not wear high-heeled shoes." B. "Begin a regular exercise program." E. "When lifting something, keep the back straight and the knees bent."

Which assessment finding indicates that a patient may have a problem with a cervical disk? Select all that apply.

A. Arm tingling B. Pain when moving the neck C. Pain radiating down the arm E. Pain radiating to the shoulder

Which information would the nurse provide to a patient receiving interferon-beta? Select all that apply.

A. Avoid crowds. B. Rotate the injection sites.

Which assessment finding increases a patient's risk for developing back pain? Select all that apply.

A. Body mass index (BMI) of 32 kg/m B. Smokes 1 pack of cigarettes per day C. Diagnosed with lumbar scoliosis E. Diagnosed with osteoarthritis of the hip

Which instruction would the nurse include when providing discharge instructions to a patient recovering from an anterior cervical diskectomy and fusion (ACDF)?

A. Do not drive.

Which treatment can provide relief from tremors in a patient with multiple sclerosis? Select all that apply.

A. Exercise program B. Thalamotomy

Which assessment finding would the nurse anticipate for a patient with an acute exacerbation of multiple sclerosis? Select all that apply.

A. Fatigue C. Double vision D. Muscle spasms

Which mechanism of spinal cord injury is caused by a sudden and FORCEFUL acceleration of the head FORWARD? A. Hyperflexion B. Hyperextension C. Excessive rotation D. Vertical compression

A. Hyperflexion hint: forceful and flexion

Which assessment finding indicates that the patient may have damage to the sacral spinal nerves?

A. Inability to void

Which situation may cause a patient with a primary spinal cord injury (SCI) to experience a secondary SCI? Select all that apply.

A. Ischemia B. Hemorrhage C. Local edema D. Hypovolemia

A patient with a herniated cervical intervertebral disk has undergone an anterior cervical diskectomy and fusion. Which postoperative intervention would the nurse include in the plan of care? Select all that apply.

A. Monitoring vital signs and neurologic status B. Assessing the airway, breathing, and circulation C. Checking for bleeding and drainage at the surgical site

Which rationale is accurate regarding the use of interferon beta-1b for patients with multiple sclerosis (MS)? Select all that apply.

A. Prevention of relapse D. Modification of disease progression

The patient reports progressive fatigue, muscle weakness, and diplopia that has worsened during the past 6 months. An MRI reveals the presence of plaques on the brain and spinal cord. Which diagnosis would the nurse anticipate?

A. Primary progressive multiple sclerosis

A patient with a T6 spinal cord injury who is in the rehabilitation unit suddenly develops facial flushing and reports a severe headache. Blood pressure is elevated, and the heart rate is slow. Which action would the nurse take first?

A. Raise the head of the bed.

A patient reports difficulty swallowing, fatigue while talking, difficulty controlling crying or laughing, and weakness of the hands and arms. The laboratory report shows increased serum creatine kinase. Which medication would the nurse anticipate being prescribed for this patient?

A. Riluzole

A patient with a history of breast cancer reports sharp, piercing pain in the lower back that increases when coughing, straining, and lying flat. Which assessment finding would indicate the likely presence of spinal tumors in the lumbosacral region? Select all that apply.

A. Sexual dysfunction D. Bladder and bowel dysfunction E. Decreased ankle and knee reflexes

Which information would the nurse emphasize when providing discharge instructions to a patient recovering from minimally invasive surgery for back pain? Select all that apply.

A. Showering is permitted after 3 days. B. Resume normal activities after 3 weeks. E. Remove the outer dressing before showering

Which medication may be prescribed for a patient with multiple sclerosis who is experiencing erectile dysfunction?

A. Sildenafil

Which information would the nurse include in teaching the patient to prevent low back pain and injury?

A. Stop smoking.

Which action would the nurse take first for a patient receiving ziconotide for chronic back pain who is experiencing disorganized thinking and hallucinations?

A. Stop the medication.

A patient is placed in a halo device to stabilize a cervical fracture. Which action would the nurse take?

A. Tape a wrench to the vest.

Which assessment finding indicates that a patient with a T2 spinal cord injury is developing a cardiovascular complication?

A. Temperature 90°F

The nurse is caring for a patient in the emergency department whose spinal cord was injured at the level of C7 1 hour ago. Which assessment finding requires the most rapid action?

A. The patient's chest moves very little with each respiration.

Which finding would the nurse expect when assessing a patient admitted with multiple sclerosis (MS)? Select all that apply.

A. Vision changes B. Difficulty walking D. Numbness in extremities E. Urinary bladder dysfunction

A patient recovering from spinal fusion surgery asks why he or she must get out of bed to walk the same day of surgery. Which response would the nurse provide?

B. "It prevents the development of blood clots in your legs."

The nurse is teaching a patient with a spinal cord injury about self-care in the halo device. Which instruction would the nurse plan to include?

B. "Keep straws available for drinking fluids."

Which statement by the patient newly diagnosed with multiple sclerosis (MS) indicates a correct understanding of the pathophysiology of the disease?

B. "Parts of my nervous system have plaques."

Which factor in a patient's health history would the nurse identify as increasing the risk for multiple sclerosis (MS)? Select all that apply.

B. Family history of MS C. Age 20 to 50 years E. Living in a cold climate

Which assessment finding indicates that a patient with a T4 spinal cord injury is developing autonomic dysreflexia? Select all that apply.

B. Flushing of the neck C. Profuse facial diaphoresis D. Heart rate 52 beats/min and irregular E. Blood pressure 150/90 mm Hg

Which instruction would the nurse give to a patient recovering from minimally invasive surgery for back pain?

B. Follow the prescribed exercise program.

Which trajectory is characteristic of progressive-relapsing multiple sclerosis?

B. Frequent relapses with partial recovery D. Progressive deterioration over the years

Which mechanism of spinal cord injury occurs when the head is SUDDENLY accelerated and then DECELERATED? A. Hyperflexion B. Hyperextension C. Excessive rotation D. Vertical compression

B. Hyperextension

Which type of spinal cord injury causes tearing of posterior ligaments and dislocation of the patient's vertebrae?

B. Hyperflexion

Which finding is an early indicator of multiple sclerosis? Select all that apply.

B. Hypoalgesia D. Decreased visual acuity E. Stiffness of the extremities

Which statement is true of back pain?

B. Low back pain is most prevalent in persons aged 30 to 70.

Which nursing intervention is the priority for a patient in the early postoperative period after anterior cervical diskectomy and fusion (ACDF)?

B. Maintenance of an open airway

A halo fixator with a jacket is used to immobilize the spine of a patient after a vertebral fracture. Which action would the nurse use to monitor the patient for neurogenic shock?

B. Monitor the patient every hour for severe hypotension.

Which disease is characterized by remissions and exacerbations of symptoms causing neurological disability?

B. Multiple sclerosis

At which location would a patient who has a lateral herniation of the nucleus pulposus in an intervertebral disk of fifth and sixth cervical vertebrae be likely to report pain?

B. Neck

A patient diagnosed with multiple sclerosis is having difficulty managing activities of daily living (ADLs) because of weakness, fatigue, and loss of balance. Which recommendation would the nurse make for this patient?

B. Perform regular exercise.

Which laboratory finding supports a diagnosis of multiple sclerosis? Select all that apply.

B. Presence of myelin proteins in the cerebrospinal fluid D. Presence of increased protein levels in the cerebrospinal fluid E. Presence of increased immunoglobulin G (IgG) antibodies in the cerebrospinal fluid

Which type of multiple sclerosis (MS) involves steady and gradual neurological deterioration without remission of the symptoms?

B. Primary progressive multiple sclerosis (PPMS)

The nurse teaches a patient who is newly diagnosed with multiple sclerosis (MS) about the disease. Which characteristic of MS would the nurse explain to the patient? Select all that apply.

B. Problems chewing C. Exacerbation and remissions D. Demineralization of the neurons F. Chronic degenerative disease of the central nervous system

The nurse is making a home visit to a patient who had spinal fusion surgery 1 week ago. Which observation of a patient action would lead the nurse to plan additional patient teaching about practices to avoid back injuries?

B. Pulling an object over the floor

Which term describes excessive sideways curvature of the spine? A. Lordosis B. Scoliosis C. Spinal shock D. Spinal stenosis

B. Scoliosis

A patient diagnosed with relapsing-remitting multiple sclerosis (MS) now reports that symptoms have become steadily progressive with no return to baseline. Which form of MS would the nurse suspect that the patient is experiencing?

B. Secondary progressive MS

A patient experiences back pain and numbness in the feet. The patient's medical record notes a narrowing of the spinal canal and nerve roots. Which disorder would the nurse suspect the patient is experiencing?

B. Spinal stenosis

Which statement about spinal cord injuries (SCIs) is correct?

B. They occur most often in young males.

Which type of trauma is the leading cause of spinal cord injuries (SCIs)?

B. Vehicle crashes

Which treatment would the nurse recommend to relieve diplopia in a patient diagnosed with multiple sclerosis?

C. Alternate an eye patch from eye to eye every few hours.

A patient returns to the surgical unit after undergoing an anterior cervical diskectomy and fusion (ACDF). Which action would the nurse take?

C. Assess airway and breathing.

A patient diagnosed with multiple sclerosis is getting ready to be discharged home. Which action would the nurse ensure is completed before the patient is discharged?

C. Assess the patient's home for hazards.

The nurse is caring for a patient after a spinal cord injury (SCI). The patient experiences a sudden rise in blood pressure, profuse sweating, and altered vision. Which condition would the nurse suspect?

C. Autonomic dysreflexia

A patient is admitted with excessive rotation of the cervical vertebra. Which assessment finding should the nurse consider as contributing to secondary injuries in this patient? S elect all that apply.

C. Blood pressure 78/56 mm Hg D. Respiratory rate 10 breaths/min and shallow E. Pulse oximeter 88% on room air

The nurse is caring for a patient after a motor vehicle crash. Which location of spinal cord injury (SCI) indicates that the patient is at high risk for respiratory compromise?

C. Cervical

The nurse reviews the health history of a patient diagnosed with multiple sclerosis. Which assessment finding would be consistent with the report of the patient developing scotomas?

C. Decreased peripheral vision

A patient diagnosed with multiple sclerosis is having issues with bowel and bladder. Which complication would the nurse suspect is causing the issues?

C. Demyelination of the spinal cord

A patient with severe chronic back pain is receiving an intrathecal infusion of ziconotide with a surgically implanted pump. Which action would the nurse take?

C. Discontinue the infusion if the patient exhibits delusions.

The nurse is caring for a postoperative patient who underwent spinal fusion surgery. The patient's respiratory rate is 28 breaths/min, and the patient is anxious and confused. The partial pressure of arterial oxygen (PaO 2) value is 60 mm Hg. Which condition would the nurse suspect?

C. Fat embolism

A patient is taking ziconotide for severe chronic back pain. For which side effect would the nurse instruct the patient to stop taking the drug and call the provider immediately?

C. Hallucinations and delusions

Which term is used for a patient's report of INCREASED sensory sensation after a spinal cord injury (SCI)? A. Paraparesis B. Hypoesthesia C. Hyperesthesia D. Quadriparesis

C. Hyperesthesia

For which complication would the nurse evaluate the patient with multiple sclerosis (MS)? Select all that apply.

C. Muscle stiffness or spasms D. Paralysis, typically in the legs E. Problems with bladder, bowel, or sexual functioning

Which drug is an immunomodulator used to treat the acute exacerbation of multiple sclerosis (MS)? Select all that apply.

C. Teriflunomide E. Interferon beta-1b

Which percentage over a patient's ideal weight would lead the nurse to recommend weight loss as an intervention for a patient with chronic back pain?

D. 10%

A patient who works on the production line at a manufacturing plant is recovering from spinal fusion surgery. When should the patient expect to be able to return to work?

D. 12 weeks

A patient with suspected multiple sclerosis is admitted to the hospital with tinnitus and numbness and tingling in the legs. The patient tells the nurse that this has happened twice before. What action would the nurse take first?

D. Ask the patient about previous occurrences.

For which finding would the nurse assess when a patient is taking teriflunomide? Select all that apply.

D. Facial flushing E. GI disturbance

Which secondary spinal cord injury typically results from decreased amount of circulating blood? A. Ischemia B. Hemorrhage C. Local edema D. Hypovolemia

D. Hypovolemia

Which pain management modality is commonly used for patients with failed back surgery syndrome?

D. Implantable stimulator

A patient with a spinal cord injury is on medication to control severe muscle spasticity. After a few days of receiving the medication, the patient experiences sedation, fatigue, dizziness, and changes in mental status. Which medication would the nurse suspect has contributed to these symptoms?

D. Intrathecal baclofen (ITB)

Which term describes back pain associated with narrowing of the spinal canal, nerve root canals, or intervertebral foramina?

D. Spinal stenosis

Which mechanism of spinal cord injury may result from a diving accident or a jump in which a person LANDS on the FEET? A. Hyperflexion B. Hyperextension C. Excessive rotation D. Vertical compression

D. Vertical compression

Which lab value would the nurse monitor in patients taking oral immunomodulating drugs? A. Platelets B. Potassium C. Hemoglobin D. White blood cells

D. White blood cells

Which position would the nurse recommend to reduce a patient's pain from a bulging lumbar disk?

D. Williams

A patient sustains a C8 spinal cord injury and is experiencing impaired motor function. Which action is the patient unlikely able to perform?

A. To form a fist

Which factor is a cause of spinal stenosis? Select all that apply.

A. Trauma B. Arthritis C. Infection D. Herniated disk

Which recommendation would the nurse make for decreasing fatigue in a patient with multiple sclerosis (MS)?

D. Keep frequently used items accessible.

Which finding is consistent with a diagnosis of multiple sclerosis? Select all that apply.

A. Vertigo B. Tinnitus C. Dysmetria D. Intention tremor E. Dysarthria

Which spinal surgical procedure uses the umbilical approach?

D. Laser-assisted laparoscopic lumbar diskectomy

A patient reports pain when moving the neck. Which diagnostic test is used to provide images of the muscles in the neck?

D. MRI

Which area of functional change would the nurse assess for a patient suspected of having early multiple sclerosis? Select all that apply.

A. Vision B. Mobility E. Sensory perception

Which finding would the nurse expect when assessing a 30-year-old patient diagnosed with multiple sclerosis (MS)?

A. Vision changes

Which diagnostic test would the nurse anticipate for the patient with back pain suspected to involve spinal tissue?

D. MRI

Which diagnostic tool would the nurse expect to be used to confirm a patient's diagnosis of multiple sclerosis (MS)?

D. MRI

Which activity recommendation would the nurse provide for the first 4 weeks after a patient's open lumbar surgery? Select all that apply.

A. Walk daily. B. Restrict driving. E. Avoid twisting at the waist.

Which observation indicates that a patient may be experiencing sciatic pain?

A. Walking with a limp

Which action would the nurse take to ensure personal safety when turning and repositioning a patient with a body mass index (BMI) of 40 kg/m who is recovering from lumbar spinal surgery?

C. Ask other health care professionals to assist.

The nurse is monitoring a patient with an acute spinal cord injury (SCI). Which finding indicates an emergency? Select all that apply.

A. Stridor B. Garbled speech D. Pulse oximetry less than 95% E. Systolic blood pressure (SBP) less than 90 mm Hg F. Mean arterial pressure (MAP) less than 65 mm Hg

The nurse performing an assessment on a patient 6 hours after diskectomy notices the presence of clear drainage from the incision site. For which finding would the nurse evaluate the patient?

A. Sudden headache

A patient is admitted with severe spasticity and tremors during an exacerbation of multiple sclerosis (MS). Which intervention would the nurse anticipate for this patient? Select all that apply.

A. Surgery C. Physical therapy D. Intrathecal baclofen pump E. Dorsal column electrical stimulation

Which recommendation would the nurse give to a patient diagnosed with multiple sclerosis who is trying to manage fatigue? Select all that apply.

A. Taking rest periods B. Keeping frequently used items nearby D. Engaging in aerobic exercise

Which statement made by a patient diagnosed with multiple sclerosis (MS) would alert the nurse that the patient requires additional education about the disease? Select all that apply.

A. "Following a low-fiber diet will prevent problems with my bowels." B. "A hot shower every day will help relax my muscles and relieve stress."

A patient has received preoperative teaching about a microdiskectomy. Which statement by the patient indicates a correct understanding of the nurse's instruction?

A. "I can go home the day of the procedure."

Which instruction would the nurse provide to the patient diagnosed with multiple sclerosis who is prescribed fingolimod? Select all that apply.

A. "Monitor your pulse every day." D. "Keep your laboratory appointments for regular white blood cell counts." E. "Facial flushing is common with this drug."

Which is the nursing priority for assessing the patient with a spinal cord injury in the emergency department (ED)?

A. Airway patency

A patient diagnosed with multiple sclerosis is having difficulty emptying the bladder. Which action would the nurse take first?

A. Assess the patient for urinary infection.

The nurse assesses a patient with multiple sclerosis (MS) for motor, sensory, cerebellar, and emotional manifestations. Which manifestation of MS affects the patient's motor function? Select all that apply.

A. Diplopia B. Scanning speech C. Spasticity of muscles F. Weakness or paralysis of limbs, trunk, and head

A nurse is planning a psychosocial assessment for a patient who recently had a spinal cord injury (SCI). Which intervention would the nurse use to assist the patient in adjusting to a disability? Select all that apply.

A. Help the patient set realistic goals and verbalize feelings. C. Assess whether the home environment can accommodate the patient's special needs. D. Tell patient about the expected reactions of those outside the hospital environment. E. Collaborate with the case manager for a review of the patient's insurance and financial status.

A patient who had spinal fusion surgery 8 months ago continues to experience severe back pain. Which intervention would the nurse expect to be considered in the collaborative plan of care for pain control? Select all that apply.

A. Nerve block C. Spinal cord stimulation D. Intrathecal spinal infusion

The nurse is caring for a patient with a spinal cord injury resulting from a diving accident. The patient has a halo fixator and an indwelling urinary catheter. The patient reports a severe headache and has an elevated blood pressure. Which medication would the nurse anticipate being prescribed?

A. Nifedipine

Which symptom is seen in patients with primary progressive multiple sclerosis (MS)? Select all that apply.

A. No acute attacks C. Steady neurologic deterioration

In addition to trauma, which assessment finding is a risk factor for back pain? Select all that apply.

A. Obesity C. Smoking F. Advanced age

Which factor contributes to back pain in the older adult? Select all that apply.

A. Osteoporosis B. Spinal stenosis C. Blood dyscrasias E. Intervertebral disk degeneration

Which term is used for a patient's report of DECREASED sensory sensation after a spinal cord injury (SCI)? A. Paraparesis B. Hypoesthesia C. Hyperesthesia D. Quadriparesis

B. Hypoesthesia

Which type of drug would the nurse expect to administer as part of the treatment plan for a patient with relapsing multiple sclerosis (MS)?

B. Immunomodulator

Which type of medication would the nurse expect will be prescribed for an adult male patient who has multiple sclerosis (MS)? Select all that apply.

B. Immunomodulator C. Stool softener D. Muscle relaxant E. Prostaglandin-5 inhibitor

Which goal would the nurse set for the care of a patient with multiple sclerosis? Select all that apply.

B. Improve function. C. Manage symptoms. D. Prevent exacerbations.

Which patient problem would the nurse prioritize when caring for a patient diagnosed with multiple sclerosis who is experiencing hypoalgesia?

B. Injury risk

Which action would the nurse take when a patient reports delusions while taking ziconotide?

B. Instruct the patient to stop taking the drug immediately

The nurse is caring for a patient who is being admitted for muscle weakness, fatigue, and vertigo. The patient reports feeling some numbness and tingling in the legs. Which question by the nurse would help identify the patient' s problem?

B. "Have you ever experienced anything like this before?"

Which statement by a patient scheduled for an arthrodesis indicates that additional teaching is required?

B. "I will go home a few hours after the surgery."

Which patient statement indicates that teaching about self-care for a halo fixation device has been effective?

B. "I will not drive until the device is removed."

A patient is admitted to the health care unit with acute spinal injuries. Which initial assessment would the nurse perform? Select all that apply.

B. Level of consciousness D. Sensory and motor function E. Airway, breathing, and circulation

Which statement about autonomic dysreflexia (AD) is accurate?

B. AD can be caused by a distended bladder.

In which area of the spine is disc herniation most common?

B. Between L4 and L5

The nurse in the postanesthesia care unit determines that a patient has a cerebrospinal fluid (CSF) leak after spinal fusion surgery. Which finding would cause the nurse to make this clinical determination? Select all that apply.

B. Bulging at the incision site C. Patient report of a sudden headache D. Large amount of clear drainage on the dressing

The nurse observes that the patient is unable to grasp a pen or form a fist when assessing motor function. Based on this assessment, what is the most likely level of spinal cord injury in the patient?

B. C8

Which collaborative problem would the nurse prioritize for patients with acute spinal cord injuries (SCIs)? Select all that apply.

B. Cardiovascular instability-related hemorrhage or interruption of sympathetic innervation C. Decreased mobility and sensation related to spinal cord damage and edema D. Respiratory distress/failure related to aspiration or decreased diaphragmatic innervation E. Secondary SCI related to hypoperfusion, edema, or delayed spinal column stabilization

Which area of the spinal column is most commonly affected by pain?

B. Cervical

Which device would the nurse recommend to help prevent pressure injury in the patient with a spinal cord injury?

B. Chair pad

A patient with severe muscle spasticity has been prescribed tizanidine. Which possible adverse effect of tizanidine would the nurse explain to the patient?

B. Drowsiness

The nurse is preparing to perform an intermittent urinary catheterization on a patient with a spinal cord injury. The patient reports a sudden onset of headache along with nausea and sweating, and the nurse assesses a blood pressure of 185/110 mm Hg. Which action would the nurse take first?

B. Elevate the head of the bed to an upright position.

Which laboratory finding is consistent with a diagnosis of multiple sclerosis? Select all that apply.

B. Elevated protein in the cerebrospinal fluid C. Immunoglobulins in the cerebrospinal fluid

Which goal is the priority when caring for a patient recovering from an anterior cervical diskectomy and fusion (ACDF)?

B. Maintaining an airway

The nurse is teaching a patient and her husband about sexual function after a spinal cord injury. Which comment by the patient indicates a correct understanding of the information?

C. "I may still be able to get pregnant."

The nurse teaches a patient about prevention of lower back pain and injuries. Which statement made by the patient indicates the need for further teaching?

C. "I will limit my intake of calcium and vitamin D."

Which statement by the patient diagnosed with multiple sclerosis indicates a need for further teaching?

C. "If my muscles are feeling tired, I will take a hot bath."

The nurse is teaching a patient about multiple sclerosis. Which statement by the patient indicates a need for further teaching?

C. "People with Asian ancestry are more likely to get multiple sclerosis."

A patient is unable to move and has no tactile sensation below the level of spinal injury after a diving accident. The health care provider is unable to elicit reflexes. The patient' s family member asks whether the patient will be paralyzed. Which response would the nurse provide to the family member?

C. "These findings may indicate a temporary response to the injury."

Which question would the nurse ask to determine the cause of a patient's acute back pain?

C. "What were you doing when the pain started?"

Which patient is at highest risk for developing multiple sclerosis?

C. A 25-year-old Caucasian woman

Which initial assessment is the priority for a patient with a spinal cord injury?

C. Airway, breathing, and circulation

A patient admitted to the intensive care unit after sustaining a cervical spinal cord injury in a motor vehicle crash is intubated and is receiving mechanical ventilation. The nurse notes a heart rate of 56 beats/min, blood pressure of 88/60 mm Hg, and warm, dry skin. Which action would the nurse take?

C. Notify the health care provider of these findings immediately.

Which change in the musculoskeletal support structures is a contributing factor for lower back pain?

C. Osteoarthritis

The nurse is assessing a patient who is recovering after lumbar spinal surgery. There is clear fluid drainage around the dressing. Which action would the nurse take?

C. Place the patient in a flat position.

Which action would the nurse take first for a patient experiencing autonomic dysreflexia (AD)?

C. Raising the head of the bed

With which health care team member would the nurse collaborate to prevent the leading cause of death for a patient with a spinal cord injury?

C. Respiratory therapist

The nurse teaches a patient with multiple sclerosis (MS) how to reduce fatigue. Which recommendation would the nurse provide?

C. Rest in a cool room.

Which technique would the heath team teach to patients with cervical neck pain? Select all that apply.

C. Seated rowing D. Shoulder shrug E. Shoulder squeeze

In assessing a patient with back pain, the nurse uses a paper clip bilaterally on each limb. Which aspect is the nurse assessing?

C. Sensation

Which item should the patient recovering from an anterior cervical diskectomy and fusion (ACDF) expect to wear after removal of the neck brace?

C. Soft cervical collar

Which intervention would the nurse plan to prevent complications of immobility when caring for a patient with a complete spinal cord injury at the C7 level? Select all that apply.

C. Special pressure-relief devices D. Regular turning and repositioning E. Assessment of skin integrity at each repositioning

Which immunomodulator drug is used in the treatment of multiple sclerosis?

D. Interferon beta-1b

Which nursing intervention is the priority for patient care after anterior cervical diskectomy and fusion?

D. Assess airway and breathing.

A patient who underwent an anterior cervical diskectomy and fusion yesterday reports dysphagia and voice hoarseness. Which intervention would the nurse implement?

D. Assess the patient's ability to swallow safely

Which action would the nurse take for a patient recovering from spinal fusion surgery who develops shortness of breath and chest pain?

D. Check the oxygen saturation.

A patient is being discharged with paraplegia secondary to a motor vehicle crash and expresses concern over the ability to adjust to the home setting after the injury. Which resource would the nurse recommend?

D. Consumer organization support group

For which condition is a patient at high risk after a cervical spinal cord injury? A. Migraine headache B. Dementia C. Cardiac arrest D. Respiratory compromise

D. Respiratory compromise

A patient is admitted to the hospital after a motor vehicle accident with a suspected spinal cord injury. Which assessment finding would the nurse address? Select all that apply.

D. Respiratory rate of 30 breaths/min, shallow and rapid breaths E. Blood pressure (BP) 90/60 mm of Hg, pulse 100 beats/min, weak and thready pulse

During physical assessment, the nurse has the patient hold the leg straight while the nurse gently lifts the leg upward. If the patient reports severe pain, which condition would the nurse suspect?

D. Sciatic nerve compression

Which statement accurately describes the Williams position?

D. Semi-Fowler with a pillow under the knees to keep them flexed

Which finding suggests to the nurse that a patient is experiencing sciatic nerve compression?

D. Severe pain when the straight leg is lifted

A registered nurse is providing emergency care to a patient experiencing autonomic dysreflexia. Which action of the nurse indicates the need for further teaching? Select all that apply.

D. Situating the patient's bed into the Trendelenburg position E. Giving a beta blocker medication to a patient with recurrent dysreflexia

Which health care team member referral would the nurse recommend for a patient experiencing dysarthria?

D. Speech-language pathologist (SLP)

Which assessment would the nurse make to monitor a patient for fat embolism syndrome (FES) after lumbar spinal surgery? Select all that apply.

E. Observe for chest pain, dyspnea, anxiety, and mental status changes. F. Note petechiae around the neck, upper chest, and conjunctiva.

Which patient condition is associated with a LOWER thoracic spinal cord injury? Paraplegia. Tetraplegia. Hemiplegia. Quadriplegia.

Paraplegia